Gufoni Maneuver Horizontal Canal BPPV

Supervisor: 褚嘉慧醫師

Reporter: 丁冠中

Benign Paroxysmal Positional Vertigo

Disease of the peripheral vestibular system

The most common cause of vertigo

Causes

Canalolithiasis: dislodged otoconia floating in the semicircular canals

Cupulolithiasis: otoconia are attached to the cupula, situated in the ampulla

The most commonly affected semicircular canal is the posterior canal

Horizontal canal BPPV accounts for 5% to 22% of cases

Horizontal canal BPPV

Two types of BPPV involving the horizontal canal

Geotropic nystagmus:

Otoconia situated in the posterior segment of the lateral canal

(canalolithiasis)

More intense when the head is turned toward the affected ear

Apogeotropic nystagmus:

Otoconia attached to the cupula (cupulolithiasis)

Free-floating within the anterior arm of the horizontal

semicircular canal near the cupula (canalolithiasis).

More intense when the head is turned toward the healthy ear.

Treatment of Lateral Canal BPPV

Maneuvers designed to detach the otolithic debris from the

cupula or to move the debris from the anterior arm of the

horizontal canal to the posterior arm

Lateral canal BPPV with geotropic nystagmus is more

responsive to treatment

The maneuvers for treatment of lateral canal BPPV

Angular accelerations (roll maneuvers, barbecue roll)

Slow gravitational sedimentation (forced prolonged positioning)

Sudden linear accelerations (Gufoni maneuver)

Gufoni Maneuver First described in 1998.

For geotropic nystagmus

Patient quickly lies down on the side of the unaffected ear and

remains in this position for 1 to 2 minutes, until the evoked

nystagmus subsides. The head is then quickly rotated 45 degrees

toward the floor and kept in this position for another 2 minutes,

after which the patient resumes an upright position

For apogeotropic nystagmus

Patient quickly lies down on the affected side and remains in this

position for 1 to 2 minutes after the nystagmus has stopped or has

been markedly reduced. Then the head is quickly turned 45

degrees toward the ceiling and is held in this position for 2 minutes,

after which the patient slowly resumes the sitting position

Gufoni Maneuver

For the geotrophic variant

one starts on the unaffected side (side of weaker nystagmus),

and then proceeds to 45 degree nose down

For the ageotrophic variant

one starts on the affected side (side of weaker nystagmus),

and proceeds to 45 degree nose up.

不論哪一種眼振，皆往弱的那一側躺

Geotrophic type 往地轉，Apogeotrophic 離地轉，每動兩分鐘。

Vannucchi’s forced prolonged position

Barbecue maneuver + forced prolonged position (FPP) vs

Gufoni maneuver.

From January 2001 to June 2008

147 patients affected by HSC-BPPV

103 Geotrophic type and 44 Apogeotrophic type

The higher percentage of success (statistically significant)

with the Gufoni maneuver at the first session of treatment

(86 vs. 61%).

The final control showed that 44 out of 54 (81%) patients

treated with the barbecue maneuver + FPP were symptom

free compared to 54 out of 58 (93%) treated with the Gufoni

maneuver.

The most evident result is the higher percentage of success

(statistically significant) with the Gufoni maneuver at the first

session of treatment (86 vs. 61%).

Both the barbecue maneuver + FPP and the Gufoni

maneuver are valid methods for treating HSC-BPPV

(geotropic forms).

a success rate of over 80% at the follow-up on the 30th day.

Conclusions

The Gufoni maneuver has a significant advantage over the

barbecue method:

the success rate shown at the follow-up, while without statistical

significance, is undoubtedly higher (93% compared with 81%)

the disorder is more quickly cured with the Gufoni maneuver

(86 of the subjects treated in this manner were symptom-free

after the first session compared with 61% of those who

underwent the barbecue + FPP method).

It is very easy to perform and that patient compliance is

better, especially if they are affected with some disorder that

limits their movement, with Gufoni maneuver

Prospective clinical study

60 patient diagnosed with HSC canalithiasis (Bilateral geotropic nystagmus)

Baloh’s maneuver (n = 13),

Vannucchi’s forced prolonged position (n = 29),

Asprella-Gufoni maneuver (n = 18).

The Asprella-Gufoni maneuver and Vannucchi’s forced

prolonged position both seem to be significantly more effective

than the Baloh’s maneuver in the treatment of HSC

canalithiasis.

with success rates of 76% and 89%, respectively, vs. 38%

The important pros of the Asprella-Gufoni maneuver versus

Vannucchi’s forced prolonged position

Patient’s convenience and maximal use of gravitational and

angular acceleration forces.

Results & Conclusions

Double-blind randomized controlled trial.

Gufoni Maneuver vs Sham maneuver

Seventy-two patients with unilateral LC-BPPV

Patients were randomly assigned to treatment by Gufoni Maneuver (n = 37) or sham treatment (n = 35).

Subjects were followed up twice (at 1 hour and 24 hours) with the supine roll test by blinded examiners.

Results & Conclusion

At 1- and 24-hour follow-up, 75.7% and 83.8% of patients,

respectively, undergoing Gufoni maneuver had recovered from

vertigo

Compared to around 10% of patients undergoing the sham

maneuver (P < 0.0001).

The first class I study on the efficacy of the Gufoni maneuver in the

treatment of LC-BPPV in both geotropic and apogeotropic forms.

The level of recommendation of the Gufoni maneuver for treating

LC-BPPV

from level U to level B for the geotropic variant

from level B to level A for the apogeotropic variant

Conclusion

There is some evidence for a significant positive effect of the

Gufoni maneuver to treat patients with lateral canal BPPV

with geotropic nystagmus.

The maneuver is easy to perform and, therefore, particularly

suitable for older, immobile, and obese patients.

However, at present, there are insufficient data to establish

the relative efficacy of this maneuver in comparison to other

maneuvers.

Thank You